“医养结合”模式下养老机构服务质量评价研究

发布时间：2018-03-12 08:14

本文选题：养老机构　切入点：服务质量评价　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的我国的老龄化呈现高速、高龄、高龄,基数大、差异大,社区养老水平低、自我养老和机构养老意识低的特点,成为我国经济社会发展的严峻问题,于此同时我国现有的卫生评价内容基本针对城市医疗服务,并没有针对养老机构的服务质量评价体系。因此本文针对"医养结合"模式下的养老机构的特殊性尝试开发一套评价量表,能够兼顾医疗的特殊性与养老的服务性,且具有良好的信度与效度,并对该量表进行初步应用。研究结果通过国内外的文献回顾,标准和政策梳理,建立了原始项目池。经过几次的专题小组讨论和一次专家咨询,得到初始量表,其量表有37个条目,根据具体内容采用李克特五分制对选项区分,个别只有三个选项的采用1,3,5计分。使用预调研的数据,153份有效问卷,检验其信度Cronbach α系数0.937、CITC系数均0.5,信度良好。KMO值达到0.7060.7,说明适合做因子分析。Bartlett的球形检定值为5540.91,显著性0.0000.05,同样说明做因子分析。在探索性因子分析阶段,应用主成分分析,提取出8个公共因子,但由于第一个因子的特征根极大,且相应的载荷过大,后面的因子趋于平缓,因此采用方差极大旋转法,计算因子载荷和交叉载荷,在单个因子的载荷0.5和交叉载荷0.4的条件下,剔除不符合要求的条目。得到29个条目。由于后三个因子解释力度不够,因此剔除后三个,将剩余的5个因子命名为:硬件设施及环境运营管理安全防护人文关怀基本健康。即为正式量表。正式调研阶段,共收到有效问卷501份,使用斯皮尔曼布朗系数进行检验发现结果为0.830,说明量表等值性状况良好;再使用α系数做内部一致性检验得到结果为0.918,结论说明量表内部一致性较高。此外,量表的校正的项总体相关性(CITC系数)值也都大于0.5,表明量表信度较高,适合进行试验。χ2/df=3.542,RMSEA=0.038,CFI=0.94,NNFI=0.91,说明本研究路径模型的拟合度较高,潜变量与观测变量的关系显著且稳固。过计算α系数发现量表中29个条目均大于0.90,效度可靠。其次,检测量表的结构效度。运用SPSS 22.0软件计算每个维度下各项目间的相关系数矩阵(皮尔森相关系数),虽然个别相关系数较小,但绝大多数相关系数都在0.60左右,表明量表的结构效度较好,适合推广。研究结论1.正式量表具有良好的信度和效度,适宜推广。2.实地走访的九家养老机构大多存在护工数量不足,医疗操作不规范,收费报销比例不统一,员工培训没有体系,个性化服务罕有,人文心理关怀欠缺等诸多问题;问卷显示的结果虽然有一部分的趋利性,但是有些比如防火防灾基本措施,几乎没有养老院可以做到,很多基本规章制度也不齐全,医疗联合的力度不够。原始量表中曾有一个选项是对于老年人的禁锢和束缚,笔者在查阅资料的时候发现国外和台湾早就讲捆绑老人视作一种尽量避免进行的措施,而预调研的结果让人很失望,几乎每一家机构都会实行束缚和禁锢,由于各种原因,这还是一个非常常见和普适的手段。因此我国的养老机构还存在各种各样的问题,硬性制度规章不规范,缺乏审核监督和改正措施,服务质量也有很大的提升空间。
[Abstract]:Objective to study the aging of our country present age, age, high speed, large base, large differences in community endowment low level of self care and institutional care consciousness is low, has become a serious problem in China's economic and social development, at the same time the health evaluation of China's basic content for City Medical service, and no the service quality evaluation system for pension institutions. Therefore, in view of the particularity of medical raising combined with the pension agency under the mode of the attempt to develop a set of evaluation scale, can take into account the particularity of the service and pension care, and has good reliability and validity, and the scale of the preliminary application results. Through the domestic and foreign literature review, standards and policy review, established the original item pool. After several panel discussions and an expert consultation, to obtain the initial scale, the scale has 37 items, according to the specific content Using Likert scale to distinguish individual options, only three options by 1,3,5 score. Using the pre survey data of 153 effective questionnaires, test the reliability coefficient of Cronbach 0.937, CITC coefficient was 0.5, the reliability is good up to the.KMO value of 0.7060.7, suitable for spherical calibration factor analysis.Bartlett = 5540.91 significant 0.0000.05, also shows that the factor analysis. The exploratory factor analysis, principal component analysis was applied to extract 8 common factors, but due to the characteristics of the first root factor is great, and the corresponding load is too large, the factor tends to be flat, so using the varimax rotation method, calculating the load factor and cross in the condition of load load, single factor and 0.5 cross load 0.4, does not conform to the requirements of the item. 29 entries. Due to three factors after interpretation is not enough, so after excluding three, will be left More than 5 factors named: the hardware facilities and environmental management safety protection of humanistic care in basic health. As a formal questionnaire. The formal investigation phase, 501 valid questionnaires were received, inspection found that the result is 0.830 using the Spielman Brown coefficient, which indicates that the scale of equivalence in good condition; and then use the alpha internal consistency coefficient test results for 0.918, conclusion the scale shows high internal consistency. In addition, the scale correction overall correlation (CITC coefficient) values are greater than 0.5, indicating that the scale has high reliability, suitable for testing. 3.542 x 2/df=, RMSEA=0.038, CFI=0.94, NNFI=0.91, the results show that the path model of high fitting degree the relationship between latent variables and observed variables, significant and stable. The calculation coefficient found scale of 29 items were higher than 0.90, validity and reliable. Secondly, the structure validity of the scale. The use of SPSS 22 software. Calculate the correlation coefficient matrix of each item in each dimension between (Pearson correlation coefficient), while the smaller individual correlation coefficient, but the vast majority of the correlation coefficient is about 0.60, the scale has a better construction validity, suitable for promotion. The conclusion of the study 1. the formal scale has good reliability and validity, suitable for.2. field visits nine pension institutions are less than the number of medical workers, the operation is not standard, the proportion of reimbursement fees are not unified, employee training system, personalized service rare, many problems such as lack of Humanistic Psychological care; questionnaire results although part of the profits, but some basic measures such as fire prevention, nursing homes can hardly so, many of the basic rules and regulations are not complete, the medical association is not enough. The original scale had an option for the elderly is the shackles and the inspection When the data found in Taiwan and abroad early say old woman as a bundle of measures to avoid, and the preliminary research results were disappointing, almost every agency will implement the bound and imprison, due to various reasons, this is a very common and universal means. Therefore pension institutions in China there are a variety of problems, rigid rules and regulations are not standardized, lack of audit supervision and corrective measures, the quality of service also has the very big promotion space.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;D669.6

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